Jeffery D. Lewis

Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease.

Objective: The aim of the study was to prospectively evaluate clinical and mucosal responses to the specific carbohydrate diet (SCD) in children with Crohn disease (CD). Methods: Eligible patients with active CD (Pediatric Crohns Disease Activity Index [PCDAI] ≥ 15) underwent a patency capsule and, if passed intact, capsule endoscopy (CE) was performed. Patients taking SCD were monitored for 52 weeks while maintaining all prescribed medications. Demographic, dietary, and clinical information, PCDAI, Harvey-Bradshaw Index (HBI), and Lewis score (LS) were collected at 0, 12, and 52 weeks. CEs were evaluated by an experienced reader blinded to patient clinical information and timing. Results: Sixteen patients were screened; 10 enrolled; and 9 completed the initial 12-week trial—receiving 85% of estimated caloric needs before, and 101% on the SCD. HB significantly decreased from 3.3 ± 2.0 to 0.6 ± 1.3 (P = 0.007) as did PCDAI (21.1 ± 5.9 to 7.8 ± 7.1, P = 0.011). LS declined significantly from 2153 ± 732 to 960 ± 433 (P = 0.012). Seven patients continued the SCD up to 52 weeks; HB (0.1 ± 0.4) and PCDAI (5.4 ± 5.5) remained improved (P = 0.016 and 0.027 compared to baseline), with mean LS at 1046 ± 372 and 2 patients showed sustained mucosal healing. Conclusions: Clinical and mucosal improvements were seen in children with CD, who used SCD for 12 and 52 weeks. In addition, CE can monitor mucosal improvement in treatment trials for pediatric CD. Further studies are critically needed to understand the mechanisms underlying SCDs effectiveness in children with CD.

Association of Disease, Adolescent, and Family Factors with Medication Adherence in Pediatric Inflammatory Bowel Disease

OBJECTIVE To examine factors associated with adolescent and parent-reported adherence to prescription and over-the-counter (OTC) medications in a cross-sectional sample of youth with inflammatory bowel disease (IBD). METHOD Ninety adolescents and their parents completed measures of medication adherence and disease, individual, and family factors while attending an outpatient gastroenterology appointment. RESULTS Longer time since diagnosis, greater perceived disease severity, and a lack of autonomous motivation to adhere predicted adolescent report of lower adherence to prescription medications. Similarly, longer time since diagnosis predicted adolescent report of lower adherence to OTC medications. Less time since diagnosis, greater maternal involvement in the medical regimen, higher perceived disease severity, and less perceived conflict predicted better parent-reported adherence to OTC medications. CONCLUSIONS Interventions for improving adherence in adolescents with IBD should address disease, individual, and family factors with special attention given to adolescents who have been diagnosed longer.

Pediatric capsule endoscopy: review of the small bowel and patency capsules.

Background and Objective: Because capsule endoscopy (CE) avoids ionizing radiation, deep sedation, and general anesthesia, CE may be valuable in pediatrics. We report a single pediatric centers experience with the use and safety of CE. Methods: In a retrospective review of consecutive CE studies, 284 CE studies were performed in 277 patients with a mean age of 15 (±3.7) years during a 5-year period. The youngest to swallow the capsule was 4.6 years old. Twenty capsules were placed. Overall, 245 (86%) patients underwent CE for suspected (184, 65%) or confirmed (61, 21%) Crohn disease (CD); 27 (9.5%) anemia or gastrointestinal bleeding; 6 (2%) polyposis; and 4 (1.4%) celiac disease. Results: Positive findings were observed in 205 (72%) of the studies, with 152 (54%) having small bowel findings. Of these, 72 (47%) were diagnostic. Gastric (95, 33%) and colonic (31, 11%) abnormalities were also identified. Five CE studies (1.8%) resulted in retention of the capsule in nonsurgical patients. A patency capsule before CE in 23 patients allowed 19 CE to proceed with only 1 retained capsule. In 65 (21%) patients, the video capsule did not enter the colon before the videos end. Of these, 36 (65%) had significant findings, including 27 (49%) documenting small bowel (SB) CD. Conclusions: CE is useful to diagnose SB disease in children. Even in a study population with a high prevalence of confirmed and suspected CD, the risk of retention remains small. The patency capsule may lessen that risk. CE may identify gastric or colonic disease even when SB lesions are not present.

Increasing Parent–Pediatrician Communication about Children's Psychosocial Problems

OBJECTIVE To examine the differential effects of two scoring procedures for a parent-completed measure, the Pediatric Symptom Checklist (PSC), designed to assess childrens behavioral and emotional functioning, on parent-pediatrician communication concerning psychosocial issues. METHODS Prior to their medical appointment, 174 parents of children aged 4-16 were assigned to one of three experimental conditions: (1) typical medical care control, (2) Staff-Scored PSC administration, or (3) Parent-Scored PSC administration. Following the appointment, parent perception of parent-pediatrician communication was assessed. RESULTS For children with more emotional and behavioral problems, participants in the Parent-Scored group and the Staff-Scored group had better parent-pediatrician communication scores than those in the control group. CONCLUSIONS Both the Staff-Scored and Parent-Scored administrations of the PSC improved parent-pediatrician communication on psychosocial issues. The Parent-Scored PSC removed the scoring burden on the medical personnel.

Behavioral Functioning in Youth With Inflammatory Bowel Disease: Perceived Barriers as Mediator of Medication Adherence

OBJECTIVES To examine the relationship between behavioral functioning specific to levels of attention and conduct problems and prescription medication adherence in youth with inflammatory bowel disease (IBD), and examine the mediational role of perceived barriers to adherence. Identifying potentially malleable factors associated with poor adherence such as behavioral functioning and barriers may guide treatment. METHODS 85 adolescents with IBD and their parents completed measures of adherence, attention and conduct problems, and barriers. To examine mediation models, indirect effects were tested using bootstrapping procedures outlined by Preacher & Hayes (2004, 2008). RESULTS The majority of participants reported normative levels of attention and conduct problems. Higher levels of attention problems, conduct problems, and barriers were negatively associated with adherence. Bootstrapping procedures indicated that barriers mediated the effects of behavioral functioning on adherence. CONCLUSIONS Barriers may be a proximal factor contributing to the relationship between everyday behavioral functioning and adherence in youth with IBD.

Skills-Based Group Intervention for Adolescent Girls With Inflammatory Bowel Disease

In this study we describe the responses of six adolescent girls with inflammatory bowel disease and their parents to a 10-session, manualized intervention program focusing on decreasing pain and functional disability in adolescents with a chronic illness, and increasing coping and sense of competency for their parents. Measures of adolescent physical symptoms and parenting sense of competence and coping were collected at pretreatment, post-treatment, and 6-month follow-up. Improvements were observed post-treatment and at 6 month follow-up on measures of adolescents’ pain and functional disability, as well as parents’ sense of competency and use of adaptive coping strategies.The potential effectiveness of this type of program and implications for its use are discussed.

Participation and attrition in a coping skills intervention for adolescent girls with inflammatory bowel disease.

The current study examined factors associated with adolescent and parent participation in a coping skills intervention for adolescent girls with inflammatory bowel disease (IBD) and examined factors associated with attrition related to intermittent missing data. Thirty-one adolescent girls with IBD and their parents enrolled in the intervention. Psychosocial and disease factors related to participation in the 6-week web component of the coping skills intervention were examined as were baseline group differences between those who provided post-treatment data and those who did not. Adolescents experiencing more difficulties related to their disease and psychosocial functioning participated less in the web component of the treatment intervention. Families who attrited had higher baseline levels of parental catastrophic thoughts, parenting stress, and adolescent depression. Families experiencing greater levels of psychological and disease-related difficulties may be at risk for low participation and eventual dropout from pediatric IBD psychological treatment interventions.

A bitter pill to swallow: Medication adherence barriers in adolescents and young adults with inflammatory bowel diseases

ABSTRACT Adolescents and young adults (AYA) with inflammatory bowel diseases (IBD) are at risk for nonadherence. This study described AYA adherence barriers and correlates of barriers. 77 AYA–parent dyads completed measures of adherence barriers. Disease frustration barriers were the most commonly endorsed barriers among AYA and parents. Females, those with Crohn’s disease, and those with active disease displayed higher levels of selected variables. AYA with IBD experience unique adherence barriers. Routine screening for barriers, especially disease frustration barriers, is warranted. Adherence-promotion interventions should be tailored to AYA’s unique experience and should emphasize disease and regimen frustration.

The Pediatric Symptom Checklist: Comparison of symptom profiles using three factor structures between pediatric gastroenterology and general pediatric patients

ABSTRACT This study evaluated and compared three different factor structures of the Pediatric Symptom Checklist (PSC) in a gastroenterology (GI) and a general pediatrics (GP) sample. Parents of GP (n = 169) and GI (n = 177) patients completed the PSC. Each structure includes internalizing, externalizing, and attention problems. Only one structure includes school problems. Hierarchical regression analyses revealed higher internalizing symptoms for GI patients across factor structures. The relationship between internalizing symptoms and age was moderated by group. The PSC seems sensitive to internalizing difficulties in GI patients regardless of factor structure. Older pediatric GI patients may be at increased risk for internalizing symptoms.